Toxic shock syndrome


Toxic shock syndrome (TSS) is a severe and potentially fatal condition triggered by toxins produced by certain bacteria, most commonly Staphylococcus aureus (staph) and occasionally by group A streptococcus (strep). Although it is often linked to tampon use during menstruation, TSS can affect anyone, regardless of age or gender. Risk factors include not only menstruation-related products like tampons and menstrual cups, but also skin wounds, surgical sites, and any other type of skin injury that provides a breeding ground for bacteria.

The symptoms of toxic shock syndrome develop suddenly and can escalate quickly, affecting vital organs such as the heart, liver, and kidneys. Despite its severity, timely diagnosis and treatment can lead to recovery in most cases. It’s critical for individuals with signs of TSS, especially if they have recently used tampons, experienced a skin injury, or had surgery, to seek medical attention immediately to mitigate risks and improve outcomes.


Toxic shock syndrome typically starts suddenly, with symptoms appearing within a few days after bacteria enter the bloodstream. The symptoms is determined by the type of bacteria causing the toxins.

Common symptoms include:

  • Chills, aches throughout the body, and other flu-like symptoms that occur suddenly.
  • A sunburn-like rash, especially on the palms and soles
  • Low blood pressure
  • Vomiting and nausea
  • Watery diarrhea
  • Conjunctivitis, or redness in the throat and eyes
  • Confusion
  • Seizures
  • Headaches
  • Feeling lightheaded, faint, or dizzy

If any of the symptoms occur, especially if one have recently had surgery, a skin wound, or used tampons, seek immediate medical attention.


Toxic shock syndrome (TSS) is primarily caused by toxins produced by the bacteria Staphylococcus aureus (staph) and Streptococcus pyogenes (group A strep), although less commonly, it can also be caused by Clostridium sordellii. Typically, these bacteria innocuously inhabit the skin or mucous membranes like the throat or mouth, but under specific conditions, some strains can proliferate rapidly and release toxins. Factors such as the use of super-absorbent tampons during a light menstrual flow or infrequent changing of tampons can facilitate bacterial growth and toxin production. Additionally, tampons can create small lacerations in the vagina, providing a pathway for bacteria to enter the bloodstream.

Apart from tampon use, TSS risks are associated with any object left in the vagina longer than recommended, including contraceptive devices like cervical caps, sponges, diaphragms, or menstrual cups. Moreover, TSS can develop from bacteria entering the body through cuts, wounds, or following medical procedures such as surgery, childbirth, or even after treating a nosebleed with packed gauze. This highlights the importance of timely medical attention and proper hygiene practices to prevent such infections.

Risk factors

Anyone is susceptible to toxic shock syndrome. People of all ages can get streptococcal toxic shock syndrome, and about half of staphylococcal TSS cases occur in menstruating women.

The risk of TSS increases with:

  • Using contraceptive sponges, diaphragms, superabsorbent tampons, or menstrual cups
  • Being afflicted with a virus, such the chickenpox or the flu
  • Having skin burns or wounds
  • Having just undergone surgery